Chapter 51

Question 1

Nerve agents block which of the following enzymes in the nervous system?
Epinephrine
Norepinephrine
Acetylcholine
Cholinesterase

Answer 1

Cholinesterase

Question 2

The likelihood of a nuclear attack on the United States is:
remote, because other nations do not have the ability to deliver a nuclear weapon via missile or bomb.
impossible, because no other nations have the resources or funding to build an effective nuclear weapon.
probable, because the whereabouts of many small nuclear devices from the former Soviet Union is unknown.
high, because many other nations have developed nuclear weapons and are able to deliver them via a missile.

Answer 2

remote, because other nations do not have the ability to deliver a nuclear weapon via missile or bomb.

Question 3

Requesting a hazardous materials team as early as possible to a scene involving a weapon of mass destruction is most important because:
you must be decontaminated prior to initiating care for any injured patients.
the hazardous materials team must quickly identify the type of weapon that was used.
it takes time for the hazardous materials team to assemble their personnel and equipment.
a member of the hazardous materials team must function as the incident commander.

Answer 3

it takes time for the hazardous materials team to assemble their personnel and equipment.

Question 4

Whether ingested or inhaled, ricin poisoning causes:
convulsions, cyanosis, and hemorrhage.
a productive cough and diaphoresis.
chest pain, muscle aches, and pulmonary edema.
fever, chills, and headache.

Answer 4

fever, chills, and headache.

Question 5

Which of the following statements regarding radiation is correct?
Radiation is unlimited as to how far it can travel through the atmosphere.
Alpha radiation can travel for several miles before losing its radioactivity.
It is impossible to recognize the type of radiation emitted from a given source.
In most cases, moving 100 feet away from the radiation source is adequate.

Answer 5

It is impossible to recognize the type of radiation emitted from a given source.

Question 6

Smallpox is in its most contagious phase when:
a headache and body aches develop.
blisters begin to form.
the patient becomes febrile.
a rash develops.

Answer 6

blisters begin to form.

Question 7

Which of the following statements regarding tabun is correct?
The primary route of exposure to tabun is through the skin.
The components used to manufacture tabun are hard to acquire.
Tabun is half as lethal as sarin and 30 to 40 times more persistent.
Tabun is twice as lethal as sarin and 50 times less persistent.

Answer 7

Tabun is half as lethal as sarin and 30 to 40 times more persistent.

Question 8

Which of the following is an example of domestic terrorism?
CCTA in Brussels, Belgium
World Trade Center attack
CCTA in Mumbai, India
Oklahoma City bombing

Answer 8

Oklahoma City bombing

Question 9

In contrast to sulfur mustard, lewisite and phosgene oxime exposures:
have a delayed onset of signs and symptoms.
cause a change in the structure of the cells.
do not result in the formation of blisters.
cause a rapid onset of signs and symptoms.

Answer 9

cause a rapid onset of signs and symptoms.

Question 10

A suicide bomber typically uses which type of weapon to achieve their objective?
Industrial chemical
Incendiary weapon
Metabolic agent
Dirty bomb

Answer 10

Incendiary weapon

Question 11

A terrorist would most likely disseminate smallpox via:
an explosion.
a powder.
a dirty bomb.
aerosolization.

Answer 11

aerosolization.

Question 12

Which of the following chemical agents has the smell of freshly cut grass?
Lewisite
Phosgene
Hydrogen cyanide
Tabun

Answer 12

Phosgene

Question 13

When triaging patients at the scene of an explosion, you should be especially aware of the fact that:
a secondary explosive device may be present.
the terrorist may still be present at the scene.
wind direction and speed may change quickly.
many explosions involve radioactive material.

Answer 13

a secondary explosive device may be present.

Question 14

If you are at the scene of an incident that potentially involves a weapon of mass destruction and other emergency resources are en route, it is most important for you to give the dispatcher information regarding the:
specific resources required.
suspected weapon involved.
best approach route.
estimated number of patients.

Answer 14

best approach route.

Question 15

Anthrax is a bacterium that:
lies dormant in a spore and is released when exposed to the optimal temperature and moisture.
results in death more than 90% of the time, regardless of how the bacterium enters a person’s body.
is highly communicable and would most likely be disseminated by a terrorist via a liquid medium.
is generally not responsive to antibiotic therapy, even if the therapy is begun immediately.

Answer 15

lies dormant in a spore and is released when exposed to the optimal temperature and moisture.

Question 16

Which of the following should make you the most suspicious of a terrorist attack or an incident involving a weapon of mass destruction?
You respond to a temple, church, or mosque for a patient who was assaulted.
A government employee presents with an acute onset of a cough and dyspnea.
You receive a call involving multiple patients with similar signs and symptoms.
A public building is evacuated when an employee notices the smell of natural gas.

Answer 16

You receive a call involving multiple patients with similar signs and symptoms.

Question 17

The seizures associated with nerve agent exposure:
are often more severe in patients with a seizure history.
will continue until a MARK 1 antidote is administered.
cannot be reversed with any pharmacologic agent.
should be treated with large quantities of a benzodiazepine.

Answer 17

will continue until a MARK 1 antidote is administered.

Question 18

While at the scene of an incident in which several patients were possibly exposed to lewisite, you are informed that an unresponsive patient with multiple blisters on his body and inadequate breathing is being brought to you for treatment. You should:
don the appropriate personal protective equipment to avoid cross-contamination.
ensure that the patient has been decontaminated before initiating any treatment.
prepare your intubation equipment and set up two IV lines of normal saline.
have the appropriate antidote ready and notify the burn center of the situation.

Answer 18

ensure that the patient has been decontaminated before initiating any treatment.

Question 19

A young woman presents with severe respiratory distress. She is conscious, but confused, and smells of freshly cut grass. Auscultation of her breath sounds reveals coarse crackles in all lung fields, and she is coughing up copious secretions. This patient’s clinical presentation is most consistent with exposure to:
phosgene.
VX agent.
soman or tabun.
chlorine

Answer 19

Phosgene

Question 20

In contrast to volatile chemical agents, nonvolatile chemical agents:
can remain on surfaces for long periods of time, usually longer than 24 hours.
include all nerve gases and remain in the environment for weeks to months.
evaporate fast when left on a surface in the optimal temperature range.
include sarin and will turn from liquid to gas within seconds to minutes.

Answer 20

can remain on surfaces for long periods of time, usually longer than 24 hours.

Question 21

Upon arriving at a scene in which the incident command system has already been established, you should:
notify the incident commander and request further instructions.
report to the treatment section and begin secondary triage.
locate the medical staging supervisor to receive your assignment.
immediately report to the triage section and begin triaging patients.

Answer 21

locate the medical staging supervisor to receive your assignment.

Question 22

Biologic agents are:
synthetically manufactured and weaponized by mixing the synthetic component with an organism.
the ideal weapons of mass destruction if the terrorist’s objective is to affect a small geographic area.
naturally occurring organisms that are cultivated, synthesized, and mutated in a laboratory.
least preferred by terrorists because they are difficult to disseminate over a large population.

Answer 22

naturally occurring organisms that are cultivated, synthesized, and mutated in a laboratory.

Question 23

Initial exposure to which of the following chemicals produces upper airway irritation and a choking sensation?
Soman
Phosgene
Phosgene oxime
Chlorine

Answer 23

Chlorine

Question 24

Which of the following statements regarding terrorism is correct?
Terrorism is defined as an attack that result in more than 10 causalities.
The majority of terrorist attacks are impulsive and unplanned.
Terrorism involves a series of attacks.
Terrorism violates the criminal laws of the United States.

Answer 24

Terrorism violates the criminal laws of the United States.

Question 25

A 21-year-old woman presents with a severe headache, body aches, and a fever of 102.8 degrees F. She tells you that she returned from a humanitarian aid mission overseas a week and a half ago and began feeling ill yesterday morning. Given this patient's travel history and clinical presentation, you should expect her to develop: bradycardia and hypersalivation. spontaneous hemorrhaging. a rash and blisters on her face. cutaneous lesions on her arms.

Answer 25

a rash and blisters on her face.

Question 26

When conducting syndromic surveillance, patients who present with signs and symptoms of which condition are especially significant? Influenza Renal failure Hepatitis Food poisoning

Answer 26

Influenza

Question 27

Signs and symptoms of nerve agent exposure include: decreased salivation. tachycardia. bronchorrhea. nausea.

Answer 27

bronchorrhea.

Question 28

The best way to protect yourself from the effects of radiation is to: wear a suit designed to completely shield yourself. wear a lead suit and self-contained breathing apparatus. use time, distance, and shielding to your advantage. limit your exposure at an incident to less than 10 minutes.

Answer 28

use time, distance, and shielding to your advantage.

Question 29

You and your partner arrive at the scene of a building explosion. As you stage your ambulance, you can see that members of the FBI are present. You also see numerous victims lying on the ground outside the building. You should: park your ambulance close to the scene without blocking in other vehicles. apprise the FBI of your presence and immediately begin triaging patients. stay where you are until you receive instructions from the staging officer. recognize that this was a terrorist attack that likely involved a chemical agent.

Answer 29

stay where you are until you receive instructions from the staging officer.

Question 30

Radiation exposure that occurs through the body is most appropriately termed: infection. internal contamination. absorption. irradiation.

Answer 30

irradiation.

Question 31

Ricin is derived from: a synthesized virus or bacterium. the seeds from a wide variety of fruits. the leaves of the purple foxglove plant. mash that is left from the castor bean.

Answer 31

mash that is left from the castor bean.

Question 32

You are at the scene of an explosion at an office complex. There are a total of 15 casualties, including 2 deaths. In addition to injuries experienced by the explosion, most of the victims are complaining of nausea, vomiting, and diarrhea. When caring for any of these victims, you must: ensure that they have been properly decontaminated first. recall that a dirty bomb does not cause radiation contamination. wear a lead shield or apron to protect yourself adequately. immediately treat those with life-threatening injuries.

Answer 32

ensure that they have been properly decontaminated first.

Question 33

A 39-year-old man presents with severe abdominal cramping accompanied by nausea, vomiting, and bloody diarrhea. During your assessment, the patient tells you that in an attempt to kill himself, he intentionally ingested some castor beans because he heard they were poisonous. The patient's blood pressure is 96/58 mm Hg, heart rate is 112 beats/min, and respirations are 24 breaths/min. Which of the following statements regarding this scenario is correct? Castor beans commonly cause the symptoms your patient is experiencing but rarely result in death. You should quickly don a mask and gown because this patient's condition is highly communicable. This patient has exposed himself to botulinum toxin and will soon experience diaphragmatic paralysis. Your patient has ingested the key ingredient for ricin and is at high risk for vascular collapse and death.

Answer 33

Your patient has ingested the key ingredient for ricin and is at high risk for vascular collapse and death.

Question 34

Which of the following statements regarding a radiologic dispersal device (RDD) is correct? Once radioactive material is placed into the RDD, it would injure or kill 10 times as many people as the explosive alone. The destructive ability of an RDD, also known as a dirty bomb, is significant because it contains a chemical agent. An RDD is any container designed to disperse radioactive material and requires the use of an explosive device. An RDD is an effective weapon of mass destruction because damage is enhanced by the radioactive material contained within it.

Answer 34

An RDD is any container designed to disperse radioactive material and requires the use of an explosive device.

Question 35

Which of the following is a preincident indicator of terrorism? Sudden increase in calls to 9-1-1 Increase in violent political activism Explosion reported at the court house Upcoming national summit meeting

Answer 35

Increase in violent political activism